RESUMEN
UNLABELLED: Tuberculosis (tbc) is a significant problem in view of diagnosis and therapy in patients on hemodialysis (HD). The object of this study was to analyse cases of tbc found among patients treated by HD at the 1st Dept. of Internal Medicine, Central Railway Hospital in the years 1971-91. Tuberculosis was found in 10 out of 182 patients eligible for analysis (5.5%), 7 of whom were men. Mean HD treatment time before diagnosis was 17 months (for the majority--less than 1 year). One patient had pulmonary tbc 6 had pulmonary tbc with extrapulmonary involvement and 3 had extrapulmonary TB only. Six patients had pericardial involvement. Clinical examination revealed malaise, lack of appetite, weight loss, fever, cough. All cultures were negative. Tuberculin test were positive in only 2 cases. In 4 cases tbc was diagnosed on necropsy. In remaining cases tbc diagnosis was based on clinical grounds, X-ray films and ineffectiveness of broad spectrum antibacterial chemotherapy in conjunction with effective antimycobacterial chemotherapy. Agents used were: rifampicin, isoniazide, ethambutol. Out of 6 treated patients 5 showed improvement. Two patients had a tbc relapse. Mean yearly incidence in our material is 33 times higher than the mean yearly incidence in the general Polish population in the years 1971-91. CONCLUSIONS: Patients on HD have a high incidence of tbc which presents diagnostic difficulties; extrapulmonary organ involvement is the rule in dialysed patients; tbc in such a setting may lead to death if untreated; effect of antimycobacterial therapy confirms diagnosis.
